A Little off the Top

GO TO: 2084 HEAD TRANSPLANTS

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Since the first human heart transplant in 1967, organ transplants have become only slightly more noteworthy than root canals. But what if your spouse, your child, or you came home from the hospital one day with not just a new heart or kidney – but a whole new body from the neck down?

It's theoretically possible: By late in the century the human head transplant might be as common as a kidney transplant is now. In fact, the technology exists today for transplanting a head onto a new body, but there's a catch: The body would be paralyzed. Still, some people could benefit. The brains of quadriplegic patients work fine, but their overall health deteriorates much faster than normal. Their lives could be prolonged significantly with a change of scenery below the chin. Someone with inoperable cancer, a degenerative heart condition, or any terminal ailment that doesn't damage the brain could live longer by throwing out the old body and stitching on a new one.

Many financial and ethical obstacles loom, but the leading booster of head transplantation is convinced it's all going to happen. "I think that sometime in the next 10 or 20 years it'll be done," says Robert White, a Case Western Reserve University neurosurgeon who performed head transplants on monkeys in a series of controversial experiments three decades ago. (The surgery worked, but the monkeys didn't live long.) After lying low, thanks in part to hostile publicity from animal-rights activists, White has reemerged as the leading advocate of head transplants. He wrote about the subject recently in Scientific American and was profiled in London's Sunday Times, in an article that made the doctor sound like he was itching to perform the cabeza shuffle for someone like Christopher Reeve.

White says that was media hype. But he is ready to operate on a qualified candidate, if someone will put up the money. He estimates that a head transplant would cost about $2 million; all he needs are the funds and a patient willing to end up, as he delicately puts it, "as a head on a pillow."

White says he knows of a number of wealthy quadriplegics who have "offered their support," but none of the would-be subjects possesses a body decrepit enough to need replacing. In any event, he says, the first head transplant will most likely be performed on a terminally ill subject who will be happy to stay alive, paralyzed or not.

"There are people who would be reassured by the fact that they could see movies, they could see their family, they could hear beautiful music, they could smell," White says. "And they could communicate. Maybe that's enough."

Enough for now. Fast-forward 85 years, and surgeons will be considering a broad range of head-transplant scenarios: Medical technology may then allow complete reattachment of a severed spinal cord.

Repairing, or even regrowing, the detached spinal cord is a major challenge for neuromedical research. Injured nerves in the central nervous system – the spinal cord and brain – never heal on their own, but one of neurology's great puzzles is that, despite this fact, nerves in the extremities do. Neurosurgeons hope to figure out why peripheral nerves grow back, and to use that knowledge to trigger spinal-nerve regrowth. In recent years, doctors have had some luck transplanting fetal nerve tissue into the spinal cords of quadriplegic cats, enabling many to walk again. In May 1999, researchers at Massachusetts General Hospital announced they had successfully regrown severed spinal nerves in rats.

The larger question is whether we should try any of this at home. One person who doubts head transplants are likely or desirable is Chet Fleming (not his real name), a practicing patent attorney who once obtained a head-transplant-related patent (since declared invalid) that he hoped to use to slow down research in this area. (You can read all about it in his 1987 book, If We Can Keep a Severed Head Alive ….) Fleming believes there is only a 5 to 10 percent chance of nonparalyzing head transplants coming to pass by 2085. The reason: Even if attaching a head to a new body is possible, getting that new body to work will be fiendishly difficult. The nerve pathways controlling every limb, every digit, every moving part will have to be located and connected to the new body's spinal cord. No one knows if that's doable.

"Regaining firsthand, effective control of the body in a nonspastic, nonparalyzed way is a great, giant chasm at this point," says Fleming. "It's possible that certain nerves that control the heart and digestive functions could be made to work. But we're standing at the edge of a Grand Canyon, and I don't think we can cross it."

Another problem is the politics of even attempting such a procedure. "One of the advantages – sometimes disadvantages – of research is that you have to get approval," White says. "You have to find a major hospital willing to incur the invasion of the press and a good deal of criticism."

White worries that doctors in the former Soviet Union will go ahead with a head transplant under less-than-optimal conditions, which could queer the procedure's entire future. He says he knows of medical interest in such an operation in Ukraine. (He belongs to the Ukrainian Academy of Medical Sciences and its Russian counterpart, and travels to the two countries often.) Officials there, White says, have frequently tried to lure him away to carry out the deed.

"The Russians have been trying, but fortunately they have no money," says White. "I can't tell you how many offers I've gotten, from Moscow, Leningrad, and Kiev. They all want me." (White also belongs to the Pontifical Academy of Sciences – but no, he hasn't discussed head transplants with the Pope.)

Fleming, on the other hand, worries that the operation will take place here in the US without proper governmental oversight. Any hospital that receives government funds – that is, almost every major hospital in the country – has a complex approval-and-oversight process for untried surgical procedures, but private clinics are often more footloose.

"At a private clinic you can do pretty much whatever you want," Fleming says. All it would need is a volunteer and a medical team led by a thrill-seeking neurosurgeon.

White's proposed procedure is, not surprisingly, elaborate and macabre. It requires an operating room twice the normal width, because a head transplant is really two operations in one. It's not like a heart or liver transplant: You can't pack a head in an ice-filled picnic cooler and load it on a helicopter. Once the head is severed, the clock starts ticking – fast – so the donor and recipient have to be right there on their own slabs. Doctors must be both nimble and meticulous, cutting off the donor's and patient's heads at the same time.

Once that's done, surgeons have an hour to complete the painstaking process of fastening the patient's dome to its new home. An hour is a long time for a severed head to live. The only reason it's possible is that White has developed a technique for cooling the brain, putting it in something like suspended animation. At 50 degrees Fahrenheit the brain's metabolism slows enough to let it survive well beyond the few minutes that a warm brain takes to expire once removed from its body.

"I've even named it the White Operation, to get a little credit for it," says White. But at this point, he can't do much more than wait. "I looked in the mail today," he says, "and I didn't see a check for $2 million."

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